.
.
Per commentor PeakVT, the CPC — sponsored by Reps. Raul Grijalva & Keith Ellison — have released their proposed budget. It hasn’t gotten much attention from the Very Serious Media enablers pundits, possibly because that would involve actual reading (many more .pdf words, fewer colorful slogans than Paul Ryan’s recycling project). Also, to be honest, Rep. Ellison is an improbably fine specimen of what my Midwestern friends call ‘Scandinavian charisma’, which does not translate well outside of the potluck supper belt, and for the Media Villagers it’s all about the optics.
Steve Benen (where I found the video) likes it:
… Keep in mind, this isn’t a fiscally irresponsible budget plan or even a plan that says fiscal responsibility is unimportant. In fact, it’s the opposite…
Earlier, I suggested that the Senate Democrats’ plan offers a bookend to the House GOP plan, but upon further reflection, that’s not quite right. Ryan aims for radicalism; Senate Dems aim for modesty. Ryan throws caution to the wind and laughs at calls for compromise; Senate Dems deliberately identify a moderate middle ground.
The actual bookend for Paul Ryan’s vision is the Congressional Progressive Caucus’ plan — it’s bold and unapologetic, presenting an agenda without real regard for whether folks on the other side of the aisle will find it worthwhile.
We’ll never know for sure whether the public would be amenable to a vision like this. In fact, I have a strong hunch more than 99% of the population will never hear a single word about the “Back To Work Budget.” But let’s be clear about one thing: on Capitol Hill, when it comes to creating millions of jobs in a hurry, this is the only game in town.
So does Matt Yglesias at EventheContrarian Slate:
… The upshot is that by 2023 spending will be about 23 percent of GDP with revenue coming in at 21.4 percent of GDP, leaving for a small and prudent budget deficit of 1.2 percent of GDP. In terms of timing, the fiscal consolidation happens pretty rapidly here. You run large deficits for the next few years, but by 2015 you’re already in arguably sustainable territory with a 3.3 percent of GDP deficit, and by 2016 it’s all the way down to 1.7 percent.
Obviously this isn’t going to be enacted and it’s in that sense not a “serious” budget. But people should take it seriously. The CPC envisions America becoming a country that has higher taxes, commits a much smaller share of national output to its military, and compensates its health care providers less generously. That’s not everyone’s cup of tea, but it’s not a wild and crazy dream. It means America would look more like the United Kingdom. Most of all it shows that the passion for reducing elgibility for Social Security and Medicare isn’t driven by the laws of mathematics. It’s driven by a desire to protect the military budget, keep taxes low, and keep provider payment rates high. Those are all reasonable things to want to do and you can see why people would want to do them, but you can also see why people don’t want to be forced into a zero sum choice between welfare state programs for the elderly and education and infrastructure programs for the future.
Schlemizel
Thats my Congressman!
Its our gift to the nation in an attempt to make up for the morans of Sterns County who cursed us with batshit Bachmann
Baud
Thanks for covering this. Although not as strong, the Senate proposal is worth talking about also. Which means the media won’t.
Pooh
As my man Chuck Pierce says, people ain’t got no jobs, people ain’t got not money, fuck the deficit.
Pooh
Of course my man Paul Krugman says that too, just with less swear words. And he’s still not “serious”.
Mnemosyne
I suspect that when Pierce says “health care providers,” he’s thinking insurance companies and hospitals, but my first thought was, “Wait, why are we supposed to pay nurses and home health aides less generously than the crap wages they’re already getting?”
Yutsano
@Mnemosyne: Think doctors, specifically speciallists. Why the hell an anesthesiologist earns about $250K in this country is beyond belief, especially considering what doctors earn in other countries.
(oh and FYWP)
Mnemosyne
@Yutsano:
And yet I don’t really think of doctors like that as “health care providers.” Your health care providers are your GP, nurses, nurse practitioners, physicians’ assistants, etc. The anesthesiologist is just there to make sure you don’t accidentally die during surgery, so there’s not much “health care” that gets provided in the grand scheme of things.
Also, too, my rep is an official Blue Dog (though he doesn’t seem to vote with them very much) but I urged him to support the CPC’s budget over Ryan’s. We’ll see how it goes.
ETA: While the anesthesiologist is making $250K, my friend’s husband, who is a cardiac ICU RN, probably makes less than half of that taking care of the patients who are desperately hoping to live long enough to use that anesthesiologist’s services. How is that fair?
Belafon (formerly anonevent)
@Mnemosyne: A lot of the reducing payments to doctors is the practice of billing for each individual thing a doctor performs, rather than billing based on the outcome.
Tissue Thin Pseudonym (JMN)
@Mnemosyne: Without an anaesthesiologist, you can’t perform a lot of surgeries. No surgeries means, in many cases, no health care. So saying that they aren’t health care providers is pretty silly. It’s also true that anaesthesiology is one of the couple of specialties (OB/GYNs are another) where the malpractice premiums really are out of control. We’d be better off in a system that pays them less, but that’s going to entail making sure that they graduate with less debt and aren’t forking a lot over to cover their liability.
Bruce s
@Mnemosyne:
It’s not fair – cut the anesthesiologists compenstion – we need to bring our system close to the Europeans’ standards – not sustainable under current skimming off the top by the overpaid elite of “providers”.
Bruce s
The Progressive Caucus are more about “fiscal responsibility” than all of the phony deficit hawks. The deficit hype is about protecting the economic elites and/or hating government. Scumbags – including Dems like Ed Rendell.
Kurzleg
@Sclemizel – Mine too, though isn’t it Anoka CTY that scourged us with Bachman?
Also (too), Ellison is a Muslim, and as result can’t be taken seriously by serious people.
Petorado
I won’t give any crap to anesthesiologists, who are skilled and intelligent people and provide an essential but risky service. CEOs (including the ones at hospitals) who spend their days trying to scheme ways of sticking a company’s profits and operating revenues into their own pockets, and have more zeros at the end of their salary than a doctor — that is a crime.
But for the Beltway media, Rep. Ellison and the rest of the CPC aren’t serious people because they have morals, intelligence, and a conscience, which by definition precludes them from “seriousness”.
Anne Laurie
@Mnemosyne: That’s not Pierce, that’s Yglesias. MattY always writes like that, because it’s a serious economists’ idea of serious economics, or something.
Mnemosyne
@Anne Laurie:
Ah, okay. I should have know that Matt “Why do barbers need licenses?” Yglasias would be equally clueless about health care and how poorly paid the providers of the majority of the care really are.
arguingwithsignposts
I think making specialists’ pay more inline with GP pay would create an opening for a lot more GP’s. There’s a shortage of those, esp. out in “the heartland,” because everyone wants to be a plastic surgeon or specialize where they don’t have to deal with icky patients, and still make lots of cash.
arguingwithsignposts
@Anne Laurie: MattY wouldn’t know economics – or grammar and spelling – if it came up and bit him on the ass. The fact that he continues to be published explains a lot about why so much media sucks.
Mnemosyne
@Tissue Thin Pseudonym (JMN):
Not necessarily. Most surgeries are technically elective, meaning that it’s not life-threatening if you don’t have it. My knee surgery was elective because I wasn’t going to die if I didn’t have my ACL replaced after I tore mine. I was just going to be physically uncomfortable and require a lot more health care in the form of physical therapy, leg braces, etc. than if they just installed a new ACL.
Sorry, but that’s a myth, at least for anesthesiologists.
Now this I completely agree with. Most doctors would probably be willing to accept smaller incomes if they weren’t simultaneously trying to pay off $200K (or more) in debt. When you have that much in loans, you’re going to pass up the $50K starting salary for a general practictioner or other GP for a higher-paying specialty so you aren’t still paying off your loans when it’s time for you to retire.
Omnes Omnibus
@Mnemosyne: Hey, he’s a balding guy who obviously cuts his own hair with a clippers, why should barbers matter to him?
Forum Transmitted Disease
Wow, this thread went from great to Romney-level cluelessness in the first ten comments.
Run on paying people less. A winning message for the Democratic Party, for sure, way to go guys, that’s some smart thinkin’ there.
1st law of politics: run on what you’re going to give people, not take away from them.
Bruce s
@arguingwithsignposts:
This
Mnemosyne
@Forum Transmitted Disease:
So here’s the proposal: new doctors who go into primary care will have starting salaries around $50K a year instead of $100K, but their student loans will be forgiven upon accepting a job in primary care.
Is that tradeoff really taking something away from them? I mean, other than taking away the student loan debt that was otherwise going to hang over their heads for the next 15 years?
FlipYrWhig
@Forum Transmitted Disease: you can run on what you’re going to give some people and take away from others. That’s worked for Republicans for like 32 years.
Omnes Omnibus
@Mnemosyne: Wipe med school debt clean after five years working in an under-served area.
Mnemosyne
@Omnes Omnibus:
Something like that, yeah. But even middle and upper-class areas are short on general practitioners right now, so I’d be willing to extend it to everyone who becomes a GP (internist, family practice, pediatrician, etc.). Everyone is going into a specialty so they can pay off those goddamned loans as fast as possible.
The prophet Nostradumbass
@Mnemosyne:
Who’s that?
I take heart that there are only 13 of those bozos left. For some reason, three of them are from California.
Mnemosyne
@The prophet Nostradumbass:
Adam Schiff. I’m not sure why, except that I assume the studios find it reassuring somehow. He generally votes the way I want on economic stuff, if it doesn’t affect the industry.
ETA: And, yes, Schiff did appear in the Colbert Report piece about the 29th District when they were doing that series.
PeakVT
Me me me me!
Oh, and the budget is hot stuff.
The prophet Nostradumbass
@Mnemosyne: He appears to no longer be a member :-), not that it makes much difference.
I think I’ll see if I can prod Anna Eshoo to at least take a look at the CPC budget.
Mnemosyne
@The prophet Nostradumbass:
I was always kind of surprised that he was a member, but he was first elected in the aftermath of the Clinton impeachment from a district that had been reliably Republican up until then, so I suppose he thought it was prudent at that point.
The Sailor
@Tissue Thin Pseudonym (JMN):
Without the janitors you can’t perform any. Well, not cleanly.
All costs and salaries need to be more aligned.
The prophet Nostradumbass
@The Sailor:
Exactly. My mom worked for a school district for many years, and got to hear a lot of garbage from teachers about stuff like that. Once, she was asked by a teacher if the classified staff would honor a picket line if they went out on strike, and her answer was “Would you honor one if we did?” I’m sure you can guess the answer.
SFAW
@Mnemosyne:
@The Sailor:
Taking potshots at anesthesiologists is easy – ZOMG! Lookit how much money they make! – but they are arguably the most important person in the OR. For the most part, they control the operation. The surgeon is certainly important, and is highly skilled, and a lousy (or even mediocre) surgeon can cause plenty of problems for the patient. But the surgeon (typically) deals with the most visible aspect of the operation, whereas the anesthesiologist deals with pretty much everything outside of the actual cutting and suturing. (And it’s often enough that the big-money surgeon has the junior person close up the patient, I think.)
I’m sure someone will jump on me for
forgettingPolandnot talking aboutrocketbrain surgery, liver transplants, etc. I’m not necessarily talking about the highly specialized/complex operations, because those are low volume procedures.ETA: Having had a few surgeries as I have become an old fart, I almost always make sure – to the extent I can – that the anesthesiologist knows what he/she is doing, before I go into surgical prep. Of course, it helps that Mrs. SFAW is in the medical profession, because she’s the one wot tells me whether the gas-passer is good or a fool.
SFAW
@The Sailor:
Whatever. I think the real point is that it doesn’t require 10 +/- years of fairly rigorous training to become proficient at being a janitor.
The prophet Nostradumbass
@SFAW:
Indeed. Fuck janitors! They’re just a bunch of unskilled dumb shits who do nothing but keeps the places we work at or live in from becoming sewers.
Actually, I suggest you go look at this website.
SFAW
@The prophet Nostradumbass:
Don’t be an asshole, tough though that may be. I called Sailor on his/her bullshit “Janitors are just as important as anesthesiologists” silliness, with his/her implied “So why should anesthesiologists be paid so much?” (which is how a lot of this thread has continued). There’s a reason they get paid more than janitors. I’ve been a janitor (although we were called “custodians”); the work ain’t fun, but I could leave my current job and do it again tomorrow, if I really needed to, and probably do a pretty decent job of it before Tax Day.
For what it’s worth, I agree that janitors should, in general, get paid a living wage – none of this minimum-wage bullshit, they should be able to support a family without needing a second job or tons of overtime. Same for “home health aides” or whatever they’re called, their wages suck, too. In general, this society seems to be unwilling to pay more to the people who do the shittiest (in the sense of “worst conditions,” not “worst performance”) jobs, because the people making the rules (so to speak), seem to think they can get away with it forever. It sucks, it should be fixed, but I’m not sure how to effect that change.
Lo mismo para ti, pendejo.
The prophet Nostradumbass
@SFAW: So then, if that’s what you allegedly believe, what the fuck was the point of your previous comment?
Cute. Chinga te, puto. And, with that, you go into the pie filter, you sack of shit.
Hilarious, coming from you.
SFAW
@The prophet Nostradumbass:
Which one? I’ve made a few.
But, since you’re going all sweetness-and-light on me, here’s the synopsis, since following a logical progression doesn’t seem to be your strong point:
1) People complained about anesthesiologists getting paid $250K per year
2) I – among others – pointed out how critical anesthesiologists are to surgeries. I opined that, in many cases, they’re more important to the surgery than the surgeon. YMMV.
3) “The Sailor” felt it incumbent upon him/herself to point out that without janitors, the surgical staff wouldn’t have a clean OR in which to work. He/she implied that, therefore, anesthesiologists’ wages ought to be more in-line with janitors’ wages.
4) I, in my own inimitable fashion, pointed out that Sailor’s “argument” was bullshit, and attempted to explain why.
5) You, apparently because your mother was (apparently) maltreated by the teachers in the school district where she was employed, chose to view this as a personal affront. You then ascribed to me something which I did not say nor imply, and told me to go fuck myself.
6) I responded to your half-witted comment, re-explained what you apparently could not understand the first three times, and returned the favor.
7) Because I apparently hurt your delicate fee-fees, you pied me. Of course, not before you got in your “chinga te, puto,” once again showing you can dish it out, but can’t take it.
I expect you will respond with yet another bon mot (French? Quelle horreur!), probably telling me something like “go fuck yourself, you fucking fuck,” followed by yet another “You’re pied AGAIN, asshole!” directed at me.
Or, alternatively, you could decide that in fact I wasn’t slamming, insulting, or denigrating janitors, and we could de-escalate.
Anton Sirius
Ref stoppage by TKO in the second round. Your winner: SFAW.
Kurzleg
@Schlemizel: Mine too, though isn’t it Anoka CTY that scourged us with Bachman?
Also (too), Ellison is a Muslim, and as result can’t be taken seriously by serious people.
Full Metal Wingnut
@Tissue Thin Pseudonym (JMN): Agreed. The case can certainly be made that specialists are overpaid, but doctor pay is not what is causing our healthcare system to spiral out of control, and it’s not a long term fix.
Mnemosyne
@SFAW:
Or that janitors’ wages should be raised to be more in line with those of anesthesiologists. But we can’t have janitors getting high wages, now can we? Sure, you’ll spare them a “living wage” out of the goodness of your heart, but you could totally do that job! Tomorrow!
I don’t think you have any clue how much you sound like Newt Gingrich right now.
Full Metal Wingnut
@SFAW: this is stupid because the people who clean ORs are not run of the mill janitors but people specially trained in the kind of cleaning a room like that needs, and are paid as such.
Which brings me to my next point. Importance is but one factor. Many specialists are overpaid, and janitors should probably be paid more, but skill also matters, and I don’t think they should make the same money.
Full Metal Wingnut
@SFAW: this is stupid because the people who clean ORs are not run of the mill janitors but people specially trained in the kind of cleaning a room like that needs, and are paid as such.
Which brings me to my next point. Importance is but one factor. Many specialists are overpaid, and janitors should probably be paid more, but skill also matters, and I don’t think they should make the same money.
Also, why are we talking about doctor compensation? While many doctors are overpaid, we should focus on what is *really* causing spiraling healthcare costs. It ain’t doctor pay.
Full Metal Wingnut
Also, 250k is pocket change. You should be angry about the specialists raking in 500, 600, 700k. I don’t find 200-250 unreasonable but it can certainly go lower without being unfair. Also, if you’re going to lower specialist pay from the 200-250 area, then the government needs to start making medical school free or subsidized significantly.
Full Metal Wingnut
Specialists at 250k aren’t even the ones you should be mad at. There are those regularly taking in double that.
All things considered, 200-250 is not terribly unreasonable, although I would not be against going lower. Although if you are going to lower it to fall in line with Europe you need to heavily subsidize med school.
Full Metal Wingnut
@Mnemosyne: so thinking a doctor should make more than a janitor makes you an asshole republican? I think everyone should make a living wage and beyond but you’re getting a little silly here.
Full Metal Wingnut
That’s ridiculous. Thinking that doctors should make 500k and janitors should make 22k makes you Newt Gingrich. There’s nothing wrong with tiered pay in itself though. Say, hospital janitor 45-60k depending on locale, OR nurse 100k, doctor 130k. Income doesn’t have to be perfectly equal, but the amount people at different levels of skill and education make should certainly be closer together.
Mnemosyne
@Full Metal Wingnut:
Given the high rates of drug-resistant hospital infections right now, I have a feeling that hospital administrators don’t feel the same way about janitorial work as you do. They seem to think that minimum wage workers are good enough and if patients get MRSA because the janitor didn’t clean the OR to the required specs, well, that’s just a new revenue stream for the hospital when they come back to have the infection treated.
Pretty much, yeah. Though it’s interesting that you immediately contradicted yourself and said that 500K actually is too much and doctors should be making more like 200K.
What most of us are saying is that doctors are simultaneously paid too much AND are graduating from college with too much debt, so the only realistic way to cut doctors’ salaries is to make it a trade-off and forgive their student loans at the same time. I don’t think that a starting salary of $50K is unreasonable for a GP in a large practice, and $100K is pretty reasonable for a surgeon or other highly trained specialist starting out. Anesthesiologists would probably fall somewhere in the middle along with other specialists like cardiologists, oncologists, nephrologists, etc.
But I think that we all agree that the “health care providers” problem that Yglasias is claiming is a problem with for-profit hospitals and insurance companies, not with the actual providers of health care.
Full Metal Wingnut
@Mnemosyne: no the 22/500 is a ridiculous disparity that I disagree with, I wasn’t being sarcastic, so no contradiction. Income should be much more equal everywhere, but not necessarily completely
Mnemosyne
@Full Metal Wingnut:
Ah, okay. I actually don’t think we disagree all that much. I don’t mind highly-trained, experienced doctors making good salaries, but I do mind that (a) they need those salaries to pay off their massive medical school debt and (b) hospital administrators use those salaries as an excuse to cut everyone else’s salaries from nurses all the way down to janitors. As many hospitals are now discovering, it turns out you can’t actually run a hospital using only a staff of surgeons. You need people to do the day-to-day patient care, too.
SFAW
@Mnemosyne:
As Shakespeare or someone else once said: give me a fucking break. Instead of projecting your own who-knows-what onto my psyche, you might have looked at it a different way: as far as I know, a lot of janitors do not currently make a living wage. They make some small amount above minimum, I expect, because that’s what administrations can get away with.
Would it have soothed your outraged sense of justice if I had said janitors should be making $40K/year? 50K? 75K? 100K? Pick whatever damn number you want, it’s OK by me. 40K in Fargo, ND, is probably much more of a living wage (excuse me for not picking a term more palatable to you, by the way) than 40K in NYC.
If I had said “live comfortably,” you probably would have gotten bent about that as well, because who the fuck is SFAW to say what’s “comfortable.” Except, of course, I didn’t set a number, because one size doesn’t fit all. When I wrote “get paid a living wage – none of this minimum-wage bullshit, they should be able to support a family without needing a second job or tons of overtime. Same for ‘home health aides’ or whatever they’re called, their wages suck, too. ” should I have added “and be able to afford vacations in Aruba every six months, plus buy a new car every 3 years“? Would that have reined in your sanctimonious rant? Probably not.
Next time I write something along those lines, I’ll try to make sure I clear it with you first.
Mnemosyne
@Full Metal Wingnut:
Also, too, this seems to be a continuation of the conversation last week about how sales people are always the last to be laid off because they generate revenue. At hospitals, doctors are the ones who generate revenue, so staff at every other level will be cut long before doctors are let go — not because of patient care, but because those doctors’ fees bring revenue to the hospital.
SFAW
@Full Metal Wingnut:
Reasonable point, except the discussion seemingly related to school janitors and similar non-specialized jobs. But whichever job, they should make a
livingwage large enough to allow a family of four or more to vacation in Aruba twice a year, plus be able to afford to buy a new high-end Lexus every three years. Because, FSM knows, anything less than that means I’m Newtie Junior.Mnemosyne
@SFAW:
Huh? The entire discussion was about doctors and hospitals and how the actual caregivers at the hospital like nurses and aides get screwed. How did you turn that into a discussion of school janitors?
That’s probably a good idea since you seem to have lost the thread of the conversation and thought we were comparing school janitors to hospital doctors instead of hospital janitors to hospital doctors.
SFAW
@Mnemosyne:
I weren’t the one who did. Go back to 31 (Sailor), 32 (Nostradumbass), and 35 (Nostradumbass again), and the slap fight that ensued between me and Nostradumbass.
Yeah, either that, or perhaps it was a sub-discussion within this thread. Oooh, which could it be? I can see how you might be confused, because, if I recall, this is THE FIRST TIME SINCE THE INTERTUBEZ WAS CREATED that one or more persons did not stay strictly on-topic.
For what it’s worth, despite our back-and-forth flaming, I don’t think we’re actually that much in disagreement regarding pay inequity, sub-human wages, and so forth. So I’ll try to refrain from being more of a dickhead than I already have been. (Honest!)
Mnemosyne
@SFAW:
Here’s what The Sailor said:
Unless they’re performing a lot of surgeries in middle schools, I don’t think that’s where the conversation turned. Nostradumbass did turn it a bit, but that was between the two of you. The rest of us were still talking about hospitals.
So you started talking about something else that the rest of us weren’t talking about, and now you’re pissed because you didn’t realize the rest of us were still talking about hospital janitors and hadn’t moved on to school janitors?
And, to answer your original question, yes, you should be worried about how well the janitor cleaned the OR before your surgery, because your great surgeon and your terrific anesthesiologist aren’t going to be able to protect you from getting a drug-resistant MRSA (staph) infection during the surgery. It’s the lowly janitor that cleaned the OR whose work is going to protect you from that.
SFAW
@Mnemosyne:
Yes, and – except for my back-and-forth with Nostradumbass, I was mindful of the OR-janitor point(s) (see #38). Nostra chose to bring the discussion to “a different level” and it was those “points” I was addressing.
Full Metal seemed to think that I was classifying OR cleaners as minimum-wage menials (or something, I’m not quite sure).
Then you chimed in with the flame about something I wasn’t doing (which you closed with the Newtie crack), I responded, etc., and here we are.
It wasn’t a completely linear progression, but it wasn’t totally out of left field, either.
SFAW
@Mnemosyne:
Well, I’m not sure there actually was a question there, but be that as it may …
I never said that cleanliness in the OR was not important, but everyone seems to be telling me that’s what I’m thinking or something.
The point I (and others) have been trying to make, and which you and (different) others seem hell-bent on turning it into something I didn’t say nor think, is that the anesthesiologist is arguably the most important medical person in the OR. This is NOT a zero-sum situation. Characterizing the anesthesiologist that way does not mean that the surgeon, the RNs, the NAs, the cleaners, the prep-and-hold personnel, or the orderlies are unimportant. What it DOES mean, in practical terms, is that it is, in general, significantly harder to replace or sub for a highly proficient anesthesiologist than it is to replace a general surgeon, a nurse, or the OR cleaner. (As I’ve written before, I’m not talking about specialties such as neurosurgeons, liver-transplant surgeons, and so forth.) It’s a function of the amount of training/experience of the person in question, along with the range of anomalous situations that may need to be handled quickly and efficiently.
MRSA is always a danger, but preventing its transmission in the OR is more of a procedural issue than a skills issue. Meaning, the cleaner implements the standard procedure/protocol, and generally does not need to have an MD, MSN, BSN, or 10 years of training/experience to be able to follow the protocol. But the cleaner IS expected to do his/her job with an acceptable level of quality/proficiency.